In This Issue
Research Spotlight:
Reduced antibiotic prescribing for children with respiratory illness
CPCE In the News:
COVID-19 News
Upcoming Events
Recent Publications
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Reduced antibiotic prescribing for children with respiratory illness
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In the August issue of Pediatrics, a multi-center team reported reduced antibiotic prescribing for children with acute respiratory tract infections (ARTIs) treated in ambulatory settings, via the Dialogue Around Respiratory Illness Treatment (DART) intervention. This is important because one-third of outpatient antibiotic prescriptions for pediatric ARTIs are inappropriate, which can lead to negative side effects at the patient and population level.
The team included Jeffrey Gerber, MD, PhD, MSCE, Robert Grundmeier, MD, and Alexander Fiks, MD, MSCE, along with colleagues from Seattle Children’s Hospital, NorthShore University Health System, the American Academy of Pediatrics (AAP), Portland State University, and UCLA.
The study used a cluster-randomized stepped-wedge clinical trial design in which 19 primary care practices from the AAP’s Pediatric Research in Office Settings (PROS) network or the NorthShore University Health System were randomized to four wedges. Data collection took place between November 2015 and June 2018. The DART intervention included evidence-based online tutorials, webinars, booster video vignette sessions, and individualized antibiotic prescribing feedback reports and was delivered to clinicians in three modules over an 11-month period.
Read the full report or a CHOP press release describing the project. In addition, previous work leading up to this study was described in CPCE’s “Promoting Antibiotic Stewardship in Pediatric Outpatient Settings” research brief.
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COVID-19 News
PolicyLab’s latest report from their COVID-Lab mapping project indicates continued risk of resurgence in the Midwest, Northeast, and major college towns, as families return from vacations and schools attempt to reopen.
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Upcoming Events
Adverse Event monitoring in oncology clinical trials: Lessons Learned
Date: September 2, 2020
Time: 12:00 - 1:00 pm
Sponsored by the CHOP Clinical Trials Research Affinity Group and presented by Tamara Miller, MD, Pediatric Oncologist and Assistant Professor, Department of Pediatrics, Emory University School of Medicine. For information about the Clinical Trials RAG or to RSVP for the seminar, please email clinicaltrialsRAG@email.chop.edu.
Promising Strategies for Encouraging the Adoption of COVID-19 Protective Behaviors
Date: September 8, 2020
Time: 4:30 - 5:30 pm
How can leaders encourage their community to adopt COVID-19 protective behaviors? Join this webinar for a discussion of promising strategies from the behavioral and social sciences to make the adoption of protective behaviors against COVID-19 more likely. Sponsored by the Societal Experts Action Network (SEAN), an activity of the National Academies of Sciences, Engineering, and Medicine. Learn more and register here.
Novel Strategies to Prevent Gender-Based Violence Among Adolescents
Date: September 14, 2020
Time: 3:00 pm ET
In a major breakthrough, randomized trials have started demonstrating there are interventions that can be used to reduce the rate of gender-based violence (GBV). In this talk, participants will first learn about the “big picture” of GBV prevention, then move into case-based discussions of adolescent GBV prevention programs in three different settings. The speakers will then synthesize all of the learning into a larger discussion of best practices and directions for future practice and research. Sponsored by the Stanford Maternal & Child Health Research Institute. Learn more and register here.
CPCE/PolicyLab Virtual Seminar Series: Opportunities for Prevention Research*
Date: September 18, 2020
Time: 12:00 noon - 1:00 pm
Presented by Alex R. Kemper, MD, MPH, MS, Division Chief of Primary Care Pediatrics at Nationwide Children’s Hospital and Professor of Pediatrics at The Ohio State University College of Medicine. Dr. Kemper is a former member of the US Preventive Services Task Force. He serves as the Chair of the Condition Review Workgroup for the U.S. Secretary of Health and Human Services Advisory Committee on Heritable Disorders in Newborns and Children. Dr. Kemper is also the Deputy Editor of Pediatrics.
Cancer and COVID-19: Update from Penn's Abramson Cancer Center
Date: September 30, 2020
Time: 6:00 - 8:45 pm
This activity is designed to focus on the major areas in which the COVID-19 pandemic has impacted how cancer care is delivered and experienced by patients. Participate in this live webcast and join the discussion on this fast moving subject while gaining up-to-date, practical information with immediate clinical and operational application. Anthony S. Fauci, M.D., Director NIAID and Founding Member of the White House Coronavirus Task Force, will deliver a keynote address. Learn more and register here.
International Workshop on Microbiome in HIV Pathogenesis, Prevention, and Treatment 2020
Dates: October 7-8, 2020
The virtual edition will provide an immersive experience to all participants through an interactive platform for real-time Q&A sessions and roundtables to fuel inspiring discussions that will move the microbiome and HIV interaction field forward. Learn more and register here.
CHOP Global Health Virtual Conference
Dates: October 9-10, 2020
The 2020 12th Annual CHOP Global Health Conference will explore how politics, governance, and leadership affect global child health. In low-, middle-, and high-income countries around the world, these key factors influence health systems in powerful ways, and affect healthcare delivery. This meeting will bring policy, political science and global child health experts together to share approaches for working with and within various political systems to positively impact child health. The meeting will also challenge and equip attendees to become advocates for child health within their own systems at the local, national, and international levels. Learn more and register here.
Diagnostic Error in Medicine 13th Annual International Conference (SIDM2020)
Dates: October 19-21, 2020
Join researchers, educators, clinicians and patients to learn about the latest work to drive diagnostic quality and safety. Virtual education events will include keynotes, breakout sessions, oral abstracts, and poster sessions. Learn more and register here.
*For CPCE/PolicyLab Virtual Seminar Series: If you would like to participate in any of the virtual events and did not receive a BlueJeans link, please contact crosss2@email.chop.edu
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Recent Publications
A team including James Guevara, MD, MPH conducted a qualitative, semi-structured interview study of Latino parents who participated in Reach Out and Read (ROR), in order to understand literacy promotion from Latino parents’ perspective and identify facilitators and barriers. Facilitators included advice from a pediatrician and receipt of a ROR book. Barriers included: (1) parents' perceptions that their children were not developmentally ready and that their children's behavior indicated they were not interested in shared reading; (2) self-perceived limited literacy and/or English proficiency; (3) parenting demands occurring in the context of poverty; and (4) continued child media use despite advice from pediatricians to choose alternate activities such as shared reading instead.
Despite growing interest in the use of technology to improve health outcomes in low- and middle-income countries (LMICs), local attitudes toward mobile health (mHealth) use in these settings are minimally understood. This is especially true in the Dominican Republic. A team including Andrew Steenhoff, MBBCh, DCH and Elizabeth Lowenthal, MD, MSCE conducted focus groups with caregivers and health promoters in the Dominican Republic to identify the use, attitudes, perceptions, and acceptability of mHealth as well as barriers to exclusive breastfeeding, as the Dominican Republic has one of the lowest exclusive breast feeding rates worldwide. They found a high level of acceptance of information and communication technology tools for breastfeeding promotion among participants. As mHealth tools can contribute to increased breastfeeding self-efficacy, identifying desirable features of such a tool is necessary to create an effective intervention. Participants wanted to receive trusted and reliable information through various formats and were interested in information beyond breastfeeding.
A team including Miren Dhudasia, MPH, Dustin Flannery, DO, MSCE, Molly Passarella, Karen Puopolo, MD, PhD, and Sagori Mukhopadhyay, MD, MMSc, aimed to determine impact of using delivery criteria to initiate antibiotics in very low birth weight and extremely low birth weight infants, using a single site cohort study from 01/01/2009 to 01/31/2020. After 04/2017, infants delivered by Cesarean section, without labor or membrane rupture were categorized as low-risk for early-onset infection and managed without empiric antibiotics. After that date, antibiotic initiation in low-risk infants decreased. Incidence of confirmed infection, death, or transfer ≤7 days age was unchanged. Thus they determined that delivery criteria may be used to optimize early antibiotic initiation among preterm infants without short-term increase in adverse outcomes.
A team including Robert Grundmeier, MD and Chén Kenyon, MD, MSHP sought to identify changes in pediatric asthma-related healthcare utilization, respiratory viral testing, and air pollution during the COVID-19 pandemic. After Mar 17, 2020, the date public health interventions to limit viral transmission were enacted in Philadelphia, in-person asthma encounters decreased by 87% (outpatient) and 84% (emergency + inpatient). Video telemedicine became the most highly utilized asthma encounter modality (61% of all visits), and telephone encounters increased by 19%. Concurrently, asthma-related systemic steroid prescriptions and frequency of rhinovirus test positivity decreased, while air pollution levels did not substantially change, compared to historical trends.
Nadia Dowshen, MD, MSHP and colleagues aimed to examine transgender adolescents and young adults’ and their parents’ preferences regarding fertility preservation (FP) information provision and discussion time, using an online survey and semistructured qualitative interviews. Survey participants preferred gender clinic physicians provide FP information, and nearly one-third endorsed mental health professionals or fertility specialists. Interview participants' FP discussion timing preferences ranged from the initial clinic visit, follow-up visits, before medical intervention, to mentioning FP early but deferring in-depth discussion to follow-up visits.
Another recent study by Nadia Dowshen, MD, MSHP and colleagues sought to quantify the health inequities experienced by gender minority blacks in the U.S. using an intersectional framework. This cross-sectional study analyzed data in 2018/2019 from the Behavioral Risk Factor Surveillance System, including all cisgender black, gender minority black, and gender minority white survey respondents who completed the gender identity module between 2014 and 2018. In the primary analysis of weighted survey data, gender minority blacks were more likely to report experiencing severe mental distress, longer periods of being physically or mentally unwell, and longer periods of activity limitations owing to poor health than cisgender blacks. In a matched analysis, gender minority blacks had worse self-reported health than both cisgender blacks and gender minority whites.
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About CPCE
We are a pediatric research center dedicated to discovering and sharing knowledge about best practices in pediatric care by facilitating, organizing and centralizing the performance of clinical effectiveness research -- research aimed at understanding the best ways to prevent, diagnose and treat diseases in children. CPCE’s multidisciplinary team conducts research on a diverse range of clinical effectiveness topics.
CPCE E-News is edited by Holly Burnside. Please feel free to contact us with questions or feedback.
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